Tobacco Product Use Among Adults — United States, 2012–2013

Despite significant declines in cigarette smoking among U.S. adults over the past five decades, progress has slowed in recent years, and the prevalence of use of other tobacco products such as cigars and smokeless tobacco has not changed. Additionally, the prevalence of use of emerging products, including electronic cigarettes (e-cigarettes), has rapidly increased. This report provides the most recent national estimates of tobacco use among adults aged ≥18 years, using data from the 2012-2013 National Adult Tobacco Survey (NATS). The findings indicate that 21.3% of U.S. adults used a tobacco product every day or some days, and 25.2% used a tobacco product every day, some days, or rarely. Population-level interventions focused on the diversity of tobacco product use, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting, in conjunction with Food and Drug Administration (FDA) regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.

On June 24, 2014, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).
Despite significant declines in cigarette smoking among U.S. adults over the past five decades, progress has slowed in recent years, and the prevalence of use of other tobacco products such as cigars and smokeless tobacco has not changed (1,2).Additionally, the prevalence of use of emerging products, including electronic cigarettes (e-cigarettes), has rapidly increased (3).This report provides the most recent national estimates of tobacco use among adults aged ≥18 years, using data from the 2012-2013 National Adult Tobacco Survey (NATS).The findings indicate that 21.3% of U.S. adults used a tobacco product every day or some days, and 25.2% used a tobacco product every day, some days, or rarely.Populationlevel interventions focused on the diversity of tobacco product use, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting, in conjunction with Food and Drug Administration (FDA) regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States (4).
The 2012-2013 NATS is a stratified, national random-digitdialed landline and cellular telephone survey of 60,192 noninstitutionalized U.S. adults aged ≥18 years.The response rate to the survey was 44.9% (landline = 47.2%, cellular = 36.3%).The survey assessed use of the following tobacco product types: cigarettes, cigars/cigarillos/filtered little cigars, regular pipes, water pipes/hookah, e-cigarettes; chewing tobacco/snuff/dip, snus, and dissolvable tobacco products.Based on documented differences in the patterns of tobacco product use (1), NATS assessed varying thresholds of lifetime use to separate established users from experimenters and nonusers.Usage thresholds for the different tobacco product types were as follows: cigarettes (≥100 times), cigars/cigarillos/filtered little cigars (≥50 times), regular pipes (≥50 times), water pipes/hookahs (≥1 time), chewing tobacco/snuff/dip (≥20 times), e-cigarettes (≥1 time), snus (≥1 time), and dissolvable tobacco products (≥1 time).Respondents who met the respective thresholds were then asked if they now used the product "every day," "some days," or "not at all."A response option of "rarely" was also provided for all tobacco products other than cigarettes based on cognitive testing suggesting that some users of these other products did not consider "some days" or "not at all" to accurately reflect their use pattern.Because of limited sample size, all smokeless tobacco products (chewing tobacco/snuff/ dip, snus, and dissolvable tobacco products) were aggregated into a single category.
Data were weighted to provide nationally representative estimates.Two definitions were used to assess the effect of occasional tobacco use on estimates of current tobacco use: 1) every day or some days, and 2) every day, some days, or rarely.Any tobacco product use was defined as use of at least one tobacco product type.*Any combustible tobacco product use was defined as use of at least one of the following tobacco product types: cigarettes, cigars/cigarillos/filtered little cigars, regular pipes, or water pipes/hookah.Tobacco use prevalence estimates were calculated overall and by sex, age, race/ethnicity, U.S. Census region, † education, annual household income, and sexual orientation.Prevalence estimates with a relative standard error ≥30% were omitted.Differences between groups were assessed using chi-squared statistics (p<0.05).
During 2012-2013, an estimated 21.3% of U.S. adults used any tobacco product every day or some days (73.4% of these used ≥1 tobacco products daily), and 19.2% used any combustible tobacco product every day or some days (72.1% of these used ≥1 combustible tobacco products daily) (Table 1).Prevalence of every day or some days use of specific tobacco products was as follows: cigarettes, 18.0%; cigars/cigarillos/ filtered little cigars, 2.0%; regular pipes, 0.3%; water pipes/ hookah, 0.5%; e-cigarettes, 1.9%; smokeless tobacco, 2.6%.An estimated 25.2% of U.S. adults reported now using any tobacco product every day, some days, or rarely (62.7% of these used ≥1 tobacco products daily), and 22.9% used any combustible tobacco product every day, some days, or rarely (60.6% of these used ≥1 combustible tobacco products daily) (Table 2).Prevalence of every day, some days, or rarely use was  Abbreviations: CI = confidence interval; GED = General Education Development certificate; LGBT = lesbian, gay, bisexual, or transgender.* Any tobacco use was defined as "every day" or "some days" use of cigarettes; cigars, cigarillos, or filtered little cigars; pipes; water pipes/hookah; electronic cigarettes; or smokeless tobacco (snus, dissolvable tobacco products, snuff, chewing tobacco, or dip).† Any combustible tobacco use was defined as "every day" or "some days" use of cigarettes; cigars, cigarillos, or filtered little cigars; pipes; or water pipes/hookah.§ Reported smoking at least 100 cigarettes during their lifetime and now smoked "every day" or "some days." ¶ Estimate not presented because relative standard error ≥30%.** Reported smoking at least 50 cigars, cigarillos, or filtered little cigars during their lifetime and now smoked "every day" or "some days." † † Reported smoking a regular pipe filled with tobacco at least 50 times during their lifetime and now smoked "every day" or "some days." § § Reported smoking tobacco in a hookah at least once during their lifetime and now smoked "every day" or "some days." ¶ ¶ Reported smoking electronic cigarettes at least once during their lifetime and now smoked "every day" or "some days." *** Smokeless tobacco users were defined using three product types: 1) chewing tobacco, snuff, or dip; 2) snus; and 3) dissolvable tobacco products.Chewing tobacco, snuff, or dip users were respondents who reported using the product at least 20 times during their lifetime and now used it "every day" or "some days." Snus or dissolvable tobacco product users were respondents who reported using each respective product at least once during their lifetime and now used it "every day" or "some days."  Abbreviations: CI = confidence interval; GED = General Education Development certificate; LGBT = lesbian, gay, bisexual, or transgender.* Any tobacco use was defined as "every day" or "some days" use of cigarettes; and/or "every day, " "some days, " or "rarely" use of cigars, cigarillos, or filtered little cigars; pipes; water-pipes/hookahs; electronic cigarettes; smokeless tobacco (snus, dissolvable tobacco products, or snuff, chewing tobacco or dip).Cigarettes not presented separately because the questionnaire only assessed "every day" or "some days" cigarette smoking.Cigarette users included in the "any tobacco product" measure includes those who reported smoking at least 100 cigarettes during their lifetime and now smoked "every day" or "some days." † Any combustible tobacco use was defined as "every day" or "some days" use of cigarettes; and/or "every day, " "some days, " or "rarely" use of cigars, cigarillos, or filtered little cigars; pipes; or water pipes/hookahs.Cigarette users included in the "any combustible tobacco product" measure include those who reported smoking at least 100 cigarettes during their lifetime and now smoked "every day" or "some days." § Reported smoking at least 50 cigars, cigarillos, or filtered little cigars during their lifetime and now smoked "every day" or "some days" or "rarely." ¶ Estimate not presented because relative standard error ≥30%.** Reported smoking a regular pipe filled with tobacco at least 50 times during their lifetime and now smoked "every day" or "some days" or "rarely." † † Reported smoking tobacco in a hookah at least once during their lifetime and now smoked "every day" or "some days" or "rarely." § § Reported smoking electronic cigarettes at least once during their lifetime and now smoked "every day" or "some days" or "rarely." ¶ ¶ Smokeless tobacco users were defined using three product types: 1) chewing tobacco, snuff, or dip; 2) snus; and 3) dissolvable tobacco products.Chewing tobacco, snuff, or dip users were respondents who reported using the product at least 20 times during their lifetime and now used it "every day, " "some days, " or "rarely." Snus or dissolvable tobacco product users were respondents who reported using each respective product at least once during their lifetime and now used it "every day" or "some days" or "rarely.Please note: An erratum has been published for this issue.To view the erratum, please click here.
Among respondents who had ever met the threshold for each product type (i.e., current and former users), current everyday use was as follows: cigarettes, 30.9%; cigars/cigarillos/filtered little cigars, 5.8%; regular pipes, 2.2%; water pipes/hookahs, 0.4%; e-cigarettes, 5.3%; chewing tobacco/snuff/dip, 17.1%; dissolvable tobacco products, 3.1%; and snus, 1.8% (Figure).Among respondents who had ever met the threshold for each product type and who now used the product (i.e., current users only), current everyday use was as follows: cigarettes, 74.2%; cigars/cigarillos/filtered little cigars, 12.8%; regular pipes, 12.6%; water pipes/hookahs, 1.2%; e-cigarettes, 17.9%; Note: Denominator for each product included respondents who had ever reached the threshold for the specified product (including current and former users).* Thresholds for the respective products were determined by asking the respondents if they had used the product a specified number of times.Frequency of cigarette smoking was determined among respondents who reported smoking ≥100 cigarettes during their lifetime (n = 26,381); frequency of cigar/cigarillos/ filtered little cigar smoking was determined among respondents who reported smoking the product ≥50 times during their lifetime (n = 6,687); frequency of regular pipe smoking was determined among respondents who reported smoking the product ≥50 times during their lifetime (n = 3,813); frequency of chewing tobacco, snuff, or dip use was determined among respondents who reported using the products ≥20 times during their lifetime (n = 5,004); frequency of water pipe/hookah (n = 4,924), electronic cigarettes (n = 5,905), snus (n = 2,337), and dissolvable tobacco products (n = 152) was determined among respondents who reported using these products at least one time during their lifetime.† Cigarettes were the only tobacco product type for which frequency of use was assessed with the response options "every day, " "some days, " or "not at all." All other tobacco product types were assessed with four response options: "every day, " "some days, " "rarely, " or "not at all." § The frequency distribution of cigarette usage at the time of the survey among those who had ever met the threshold was as follows: everyday (30.9%), some days (10.8%), or not at all (58.3%).For all other tobacco products, frequency distribution of usage at the time of the survey for everyday, some days, rarely, or not at all, respectively, among those who had ever met the respective thresholds was as follows: cigars/cigarillos/filtered little cigars (5.8%, 9.8%, 30.1%, and 54.3%), regular pipes (2.2%, 3.9%, 11.6%, and 82.3%), water pipes/hookahs (0.4%, 3.9%, 27.1%, and 68.6%), electronic cigarettes (5.3%, 8.3%, 16.2%, and 70.2%), chewing tobacco/ snuff/dip (17.1%, 7.7%, 10.8%, and 64.5%), dissolvable tobacco products (3.1%, 4.3%, 10.9%, and 81.7%), and snus (1.8%, 3.7%, 10.4%, and 84.1%).

FIGURE.
FIGURE.Percentage of persons who used selected tobacco products among those who met established thresholds,* by product type and frequency of use -National Adult Tobacco Survey, United States, 2012-2013